It's a well-known fact that men and women who behave the same way in the exact same situation—whether it's a job interview, a cocktail party, or a traffic stop—are sometimes perceived and treated differently based on their gender.
Something similar, it seems, may happen when men and women start to show signs of depression. A new study, published this week in the journal PLoS ONE, suggests that people of both sexes are less likely to view men as being depressed and in need of professional help—even if a man's symptoms are identical to a woman's.
"A lot of attention has been paid to depression in women, and with good reason: Depression is twice as common in women," says James B. Potash, MD, the editor of the study and a professor of psychiatry at the University of Iowa, in Iowa City. "There has been relatively little focus on education about depression in men. This [study] emphasizes the importance of figuring out how to get through to men that depression can be disabling and treatment is important."
In the study, researchers in the U.K. asked a group of about 600 adults to read a short description of a hypothetical depressed person. This vignette, which was designed to illustrate the diagnostic criteria for clinical depression (also known as major depression), read in part:
For the past two weeks, Kate has been feeling really down. She wakes up in the morning with a flat, heavy feeling that sticks with her all day. She isn't enjoying things the way she normally would. In fact, nothing gives her pleasure. Even when good things happen, they don't seem to make Kate happy.
Fifty-seven percent of the study participants recognized Kate's symptoms—which also included difficulty concentrating, fatigue, and insomnia—as indications of a mental health disorder, and more than three-quarters of those people correctly identified the disorder as depression. Only 10% of the respondents said Kate did not have a problem.
The researchers presented the same vignette to another group of 600 people. This time, however, every mention of "Kate" was replaced by "Jack," and all the pronouns were switched from female to male. Those minor changes had a noticeable effect: Though nearly as many people recognized Jack as having a mental health problem (52%), more than twice as many as in the Kate scenario said he did not (21%).
In addition, men themselves were less likely than women to label Jack depressed—a pattern that was not seen in the Kate case.
Why the differences? Male stereotypes that emphasize traits such as toughness and strength may dissuade both women and men, and especially the latter, from identifying or acknowledging the signs of depression in men, says study author Viren Swami.
"Men are expected to be strong, deny pain and vulnerability, and conceal any emotional fragility," says Swami, a psychologist at the University of Westminster, in London. "Because of these societal expectations, men appear to have poorer understanding of mental health and aren't as good at detecting symptoms of depression compared with women."
Potash says the findings also may reflect the fact that women are generally more attuned to emotions and better at articulating them. Some men might have all the outward signs of depression, and yet when asked about their mood they "may not be able to say much more than 'I don't know,'" he says. "A substantial minority of men just don't describe depression."
On a deeper level, men's failure to recognize the symptoms of depression in a fellow male may represent a kind of defense mechanism prompted by an "unconscious identification" with that man, says Radu Saveanu, MD, a professor of psychiatry at the University of Miami Miller School of Medicine.
"They may think, 'If this guy is having trouble and may need treatment, I may be in the same position someday,'" says Saveanu, who was not involved in the study. "That anxiety distorts the ability to be more objective."
All of these dynamics may affect the likelihood of seeking or recommending treatment. In the study, men were more likely than women to recommend that Kate seek professional help, but this gap disappeared in the Jack scenario. Men also expressed less sympathy for Jack than women did.
The reluctance to seek treatment isn't unique to men, but it does reflect an independent-minded streak that is more common among males, Potash says. Men tend to think that pulling themselves out of depression is "something they ought to be able to do," he says. "It's the stereotype of men who never ask for directions. They won't admit that they can't take care of it themselves."
Gender, of course, isn't the only factor that shapes how we view depression symptoms. Swami also found that respondents of either sex who held negative attitudes towards psychiatry and science felt that both Kate and Jack's symptoms were less distressing, more difficult to treat, and less worthy of sympathy or treatment.
Swami took these trends into account, but he can't rule out that other factors might have influenced the gender differences seen in the study. The participants' own mental health history was unknown, for instance, though Swami says previous diagnoses do not tend to impact "mental health literacy."
Future research will need to address these limitations, he says.